1508865346 NPI number — CITY OF CAMPBELLSVILLE KY

Table of content: (NPI 1508865346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508865346 NPI number — CITY OF CAMPBELLSVILLE KY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CAMPBELLSVILLE KY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508865346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 SOUTH COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-6717
Provider Business Practice Location Address Fax Number:
270-789-3135
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
270-465-3504

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1864176 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086909900 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 56027774 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2445149000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200201650A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55001101 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00248582 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000340594 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2645221 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063010 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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